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Organization
SHELLY SELF DMD PLLC
Active
Organization
SHELLY SELF DMD PLLC
Active
Other names
Poulsbo Children's Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
MCKINLEY T SELF DMD (MANAGER)
(360) 464-0779
Entity
Organization
Contact information
Practice address
19365 7TH AVE NE, SUITE D 108, POULSBO, WA 98370-7441
(360) 779-7115
(360) 779-3990
Mailing address
19365 7TH AVE NE, SUITE D 108, POULSBO, WA 98370-7441
(360) 779-7115
(360) 779-3990
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DE10256
WA
Other
Enumeration date
04/07/2014
Last updated
04/07/2014
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